在髋关节翻修术中应用3D打印个性化生物型臼杯的疗效分析

Clinical effect analysis of the 3D printing individual biological acetabular cup application in hip revision surgery

目的探讨3D打印个性化生物型臼杯在伴有髋臼骨缺损患者人工髋关节翻修术中的应用及疗效。方法回顾分析2016年1月至2017年7月徐州医科大学附属医院骨科采用3D打印技术制作个性化生物固定型臼杯联合植骨翻修的PaproskyII型及PaproskyIIIA型髋关节置换术后松动伴髋臼侧骨缺损者21例,其中男9例,女12例,年龄为68~85(76.3±8.1)岁。所有手术均为初次单侧翻修,初次关节置换髋臼侧骨水泥固定9例,生物型固定11例,人工股骨头置换1例。术后定期随访,采用Harris评分方法及疼痛视觉模拟评分(VAS)评估髋关节功能及状态,根据X线片判断假体稳定性及植骨愈合情况。结果21例患者随访23~27(24.3±0.5)个月,X线片显示移植骨与宿主骨交界处有连续性骨小梁通过,患者下地行走步态良好。术前患髋的Harris评分为(41.5±9.6)分,术后6个月(82.3±5.0)分(P<0.01);术后12个月(86.9±5.6)分(P<0.01);术后24个月(87.7±5.0)分(P<0.01);术前VAS评分为(4.1±1.2)分,术后6个月(0.72±0.89)分(P<0.01);术后12个月(0.69±0.55)分(P<0.01);术后24个月(0.51±0.77)分(P<0.01)。手术前后两种评分的差异均有统计学意义。结论采用3D打印个性化生物型臼杯联合植骨进行PaproskyII型及PaproskyIIIA型髋臼骨缺损翻修手术,可获得满意疗效。

Objective To analyze the effect of 3D printing individual biological acetabular cup application in revision hip arthroplasty for patients with acetabular bone defect.Methods A retrospective analysis was conducted on 21 cases(9 males and 12 females)of prosthesis loosening after hip arthroplasty with acetabular lateral bone defects of Paprosky II and Paprosky III A types from January 2016 to July 2017.3D printing individual biological acetabular cups were used in the hip revision surgery.The age of patients,included in this study,were 68-85(76.3±8.1)years.All the operations were primary unilateral revision.The fixing methods of acetabular side in the initial joint replacement included bone cement fixation(9 cases),biological fixation(11 cases)and artificial femoral head replacement(1 case).Harris method and scorevisual analogue score(VAS)were used to assess the function and status of the hip joint,while X-ray was used to evaluate the stability of the prosthesis and the bone graft healing.Results The 21 patients were followed up for 23-27(24.3±0.5)months.X-rays showed continuous trabecular between the graft and the host.The patient walked well with good gait.Harris hip score:preoperative score was 41.5±9.6,6 months postoperative 82.33±5.04(P<0.01),12 months postoperative 86.9±5.6(P<0.01),24 months postoperative 87.7±5.0(P<0.01).VAS score:preoperative score was 4.06±1.23,6 months,postoperative 0.72±0.89(P<0.01),12 months postoperative 0.69±0.55(P<0.01),24 months postoperative 0.51±0.77(P<0.01).The difference of two kinds of scores after operation is statistically significant compared with that before operation.Conclusion 3D printing individual biological acetabular cup combined with bone grafting can achieve satisfactory results in the hip revision surgery with acetabular bone defect of type PaproskyII and type Paprosky IIIA.